SpinAnk project: Potential neuromodulatory effects of degenerative spinal disc disease with neural compression predisposing to foot and ankle injuries.

SPINANK (SPINe–ANKle) is a phased, non-interventional observational research program designed to explore the relationship between pre-existing spinal pathology and ankle and foot injuries. The study is conducted in three sequential phases. Phase 1 is a pilot cross-sectional descriptive study of patients presenting with ankle injuries, aimed at estimating the prevalence of documented spinal pathology and characterising basic demographic, clinical, and imaging features. Preliminary pilot data suggest that approximately 15.6% of patients with ankle injuries have associated spinal pathology; however, this finding may be incidental or related to confounding factors, and therefore requires further investigation. Phase 2 is a retrospective cohort analysis of patients with known spinal pathology, stratified by spinal region (cervical, thoracic, lumbar, or multi-level involvement) and severity, to assess the frequency, type, and characteristics of ankle injuries within this population. Phase 3 expands the scope to include the full spectrum of foot and ankle injuries. This phase aims to evaluate the prevalence of known or newly identified spinal pathology in patients presenting with foot or ankle injuries and to identify clinical patterns that may warrant further spinal investigation. Across all phases, the study seeks to clarify whether observed associations between spinal pathology and distal lower-limb injuries represent incidental coexistence or reflect clinically meaningful relationships related to neurological impairment, balance, or gait dysfunction. The findings are intended to inform future hypothesis-driven studies and to support the development of pragmatic clinical screening frameworks. SPINANK is an observational study using retrospective and/or prospectively collected clinical data. No interventions are assigned, and all analyses are exploratory and descriptive or associative in nature. Ethical approval will be obtained as required by local institutional governance frameworks.